Complex cases and coordination: Reports from organ donation specialists in Canada

OBJECTIVES: To explore Organ and Tissue Donation Coordinator nurses' experiences and perceptions of their most challenging and complex cases, with a focus on emotional, ethical, and procedural factors. METHODS: Qualitative descriptive study where data were collected using a semi-structured interview guide and analyzed using a thematic analysis approach. FINDINGS: 29 coordinators were interviewed from April 2022 to February 2023 across all Canadian provinces. Most coordinators have been in their role for 6.9 years, and have experience in critical care. Two overarching themes captured the complexity of coordinators' experiences: (1) Donation Type, encompassing donation after death determination by circulatory criteria and specific donor circumstances, and (2) Pediatric versus Adult Contexts, highlighting contrasts in family, patient, recipient, and team dynamics. Donation after death determination by circulation criteria cases were characterized by procedural pressure due to sensitivity. In contrast, specific donor types, such as patients undergoing medical assistance in dying, intensified emotional and ethical strain through personal connections with donors. Pediatric cases further amplified emotional complexity, extending family interactions and deepening the search for meaning in care. CONCLUSION: Our findings highlighted that coordinators face significant challenges in complex organ and tissue donation cases and there is a current need for targeted interventions to psychologically enhance support systems and improve the coordination of deceased organ donation. IMPLICATIONS FOR CLINICAL PRACTICE: Understanding the multifaceted challenges coordinators encounter in complex donation contexts in critical care can inform future training development, psychosocial support, and interdisciplinary communication strategies, thereby improving the overall quality of care provided during donation processes.